Angela Jackson
Individual provider Active NPI Specialist · Pittsfield, ME
NPI 1013468248 · NPPES record last updated Oct 24, 2016
Key facts
- NPI
- 1013468248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 1666300 (ME)
- Practice address
- 110 E St
Pittsfield, ME 04967-5106 - Phone
- (207) 355-4026
- NPI assigned
- Oct 24, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1666300 | ME | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1666300 | ME | Yes |
Addresses
Primary practice location
110 E St
Pittsfield, ME 04967-5106
Mailing address
110 E St
Pittsfield, ME 04967
Phone (207) 355-4026
Other providers in Pittsfield, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.